Comparison of efficacy of modified EOX and FOLFIRI regimens in treatment of metastatic gastric cancer

Li, Jian-Wang

doi:10.11569/wcjd.v24.i12.1866

Cited by 3 publications

(1 citation statement)

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“…We excluded thirty-fve articles with conference abstracts or without outcome measures. 8 RCTs were included in the meta-analysis [8][9][10][11][12][13][14][15].…”

Section: Selection Process Of Included Literature As Shown Inmentioning

confidence: 99%

Meta-Analysis of Capecitabine versus 5-Fluorouracil in Advanced Gastric Cancer

Zhang

et al. 2023

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the effect of capecitabine versus 5-fluorouracil in advanced gastric cancer patients. Methods. We searched PubMed, Cochrane Library, Embase, and other databases from database establishment to June 2022, containing randomized controlled trials (RCT) on capecitabine and 5-fluorouracil in advanced gastric cancer patients. A meta-analysis was conducted to evaluate the effect of capecitabine versus 5-fluorouracil on overall response rate, neutropenia, thrombocytopenia, stomatitis, hand-foot syndrome, nausea and vomiting, alopecia, and diarrhea. Results. Eight RCTs with a total of 1998 patients with advanced gastric cancer were finally included, including 982 with capecitabine and 1016 with 5-fluorouracil. Compared with 5-fluorouracil, capecitabine use was significantly associated with an improved overall response rate in patients (RR 1.13, 95% CI 1.02–1.25, P = 0.02 ). Compared with 5-fluorouracil, treatment with capecitabine was significantly associated with decreased neutropenia events (RR 0.78, 95% CI 0.62–0.99, I2 = 86%, P = 0.04 ), and a decreased risk of stomatitis (RR 0.73, 95% CI 0.64–0.84, I2 = 40%, P < 0.0001 ) in patients with advanced gastric cancer. In terms of hand-foot syndrome, capecitabine was associated with increased hand-foot syndrome events than 5-fluorouracil (RR 2.00, 95% CI 1.21–3.31, P = 0.007 ). In terms of thrombocytopenia, nausea and vomiting, alopecia, and diarrhea, the effect of capecitabine and 5-fluorouracil were similar ( P > 0.05 ). Conclusions. Compared with 5-fluorouracil, capecitabine treatment improves the overall response rate and reduces the risk of neutropenia and stomatitis in advanced gastric cancer patients. It should be noted that capecitabine treatment may also increase the occurrence of hand-foot syndrome. Capecitabine is similar to 5-fluorouracil in causing thrombocytopenia, nausea and vomiting, alopecia, and diarrhea.

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“…We excluded thirty-fve articles with conference abstracts or without outcome measures. 8 RCTs were included in the meta-analysis [8][9][10][11][12][13][14][15].…”

Section: Selection Process Of Included Literature As Shown Inmentioning

confidence: 99%

Meta-Analysis of Capecitabine versus 5-Fluorouracil in Advanced Gastric Cancer

Zhang

et al. 2023

Evidence-Based Complementary and Alternative Medicine

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Chemotherapy for advanced gastric cancer

Wagner

Syn

Moehler

et al. 2017

Cochrane Database of Systematic Reviews

774

484

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Chemotherapy improves survival (by an additional 6.7 months) in comparison to BSC, and combination chemotherapy improves survival (by an additional month) compared to single-agent 5-FU. Testing all patients for HER-2 status may help to identify patients with HER-2-positive tumours, for whom, in the absence of contraindications, trastuzumab in combination with capecitabine or 5-FU in combination with cisplatin has been shown to be beneficial. For HER-2 negative people, all different two-and three-drug combinations including irinotecan, docetaxel, oxaliplatin or oral 5-FU prodrugs are valid treatment options for advanced gastric cancer, and consideration of the side effects of each regimen is essential in the treatment decision. Irinotecan-containing combinations and docetaxel-containing combinations (in which docetaxel was added to a single-agent or two-drug (platinum/5-FUcombination) show significant survival benefits in the comparisons studied above. Furthermore, docetaxel-containing three-drug regimens have increased response rates, but the advantages of the docetaxel-containing three-drug combinations (DCF, FLO-T) are counterbalanced by increased toxicity. Additionally, oxaliplatin-containing regimens demonstrated a benefit in OS as compared to the same regimen containing cisplatin, and there is a modest survival improvement of S-1 compared to 5-FU-containing regimens.Whether the survival benefit for three-drug combinations including cisplatin, 5-FU, and epirubicin as compared to the same regimen without epirubicin is still valid when second-line therapy is routinely administered and when cisplatin is replaced by oxaliplatin and 5-FU by capecitabine is questionable. Furthermore, the magnitude of the observed survival benefits for the three-drug regimens is not large enough to be clinically meaningful as defined recently by the American Society for Clinical Oncology (Ellis 2014). In contrast to the comparisons in which a survival benefit was observed by adding a third drug to a two-drug regimen at the cost of increased toxicity, the comparison of regimens in which another chemotherapy was replaced by irinotecan was associated with a survival benefit (of borderline statistical significance), but without increased toxicity. For this reason irinotecan/5-FU-containing combinations are an attractive option for first-line treatment. Although they need to be interpreted with caution, subgroup analyses of one study suggest that elderly people have a greater benefit form oxaliplatin, as compared to cisplatin-based regimens, and that people with locally advanced disease or younger than 65 years might benefit more from a three-drug regimen including 5-FU, docetaxel, and oxaliplatin as compared to a two-drug combination of 5-FU and oxaliplatin, a hypothesis that needs further confirmation. For people with good performance status, the benefit of second-line chemotherapy has been established in several RCTs.

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